Hue University of Medicine and Pharmacy THE 17th ASIAN CONFERENCE ON CLINICAL PHARMACY MEDICATION ERRORS RELATED TO ANTIBIOTICS: PREVALENCE, POTENTIAL CLINICAL OUTCOME & RISK FACTORS Thi-Ngan-Thao NGUYEN1, Thi-Hang DO1, Thi-Hong-Lien DUONG2, Quang-Phuc TRAN3, Ha-Minh-Khue DUONG3, Thi-Ha VO1,3 1Faculty of Pharmacy, Hue University of Medicine and Pharmacy, Hue, Vietnam 2Depart of Nursing, Hue University Hospital, Hue, Vietnam 3Depart of Pharmacy, Hue University Hospital, Hue, Vietnam Thi-Ngan-Thao Nguyen1, Thi – Hang Do1, Thi-Hong-Lien Duong2, Quang-Phuc Tran3, Ha-Minh-Khue Duong3, Thi-Ha Vo1,3 Indonesia, 07/2017 Hue University of Medicine and Pharmacy

CONTENT BACKGROUND 1 METHODS 2 RESULTS 3 CONCLUSIONS 4 5 Kiến nghị

I BACKGROUND 3 Antibiotics was a drug group with highest risk of ME (79,6%) (3). Dealth rate related antibiotics was 7.5%, 4th in drug group (4) . 2 Medication errors (ME): 3rd cause of dealth in USA. (1) In Vietnam, 37.7- 68.6%/dose administration by nurses having ME. (2) Vietnamese Minister of Health issued “Guidelines of antibiotic use” in 2015 & “Hospital antibiotic stewardship programs» in 2016. Detecting MEs related antibiotics => solutions => Improve quality of hospital antibiotic stewardship Martin A Makary and Michael Daniel. Medical error—the third leading cause of death in the US. 2016 , http://www.bmj.com/content/353/bmj.i2139. Dương Thị Thanh Tâm (2014), Đánh giá an toàn trong thực hành thuốc cho trẻ em tại một cơ sở y tế ở Việt Nam, Luận văn Thạc sĩ Dược học, Đại Học Dược Hà Nội. Huong Thao Nguyen, et al., Medication Errors in Vietnamese Hospitals: Prevalence, Potential Outcome and Asscociated Factors, in PLOS ONE. 2015. Phillips J. et al (2001), "Retrospective analysis of mortalities associated with medication errors", Am J Health Syst Pharm. 58(19), pp. 1835-1841

I OBJECTIVES Objectives 1. Detect MEs during antibiotic administration to patients by nurses Objectives 2. Evaluate potential clinical severity of those MEs Text in here Text in here 3. Determine risk factors of those MEs

II METHODS Process Direct observation of preparation and administration of each antibiotic dose performed by nurses to patients Place A 600-bed university hospital in 3 clinical wards: Cardiovascular Medicine Internal Medicine Gastroenterology Surgery Thời gian 12/2016 - 01/2017 7h30 - 18h30 daily 7 consecutive days/each ward

II METHODS Inclusion criteria Exclusion criteria All observation of preparation and administration of antibiotics peformed by nurses to patients with the same injection trolleys Exclusion criteria Emergency case

Tổng cơ hội xảy ra sai sót TOE II METHODS Definition Medication error Is defined as any difference preparation and administration by nurses compared to: (1): Physician prescription (2): Guide of Manufacturer Company (3): Books: Injectable Drugs Guide I.V. Drug Handbook Nursing Drug Handbook STABILIS Cơ hội xảy ra sai sót OE Tổng cơ hội xảy ra sai sót TOE

II METHODS Each ME was evaluated independently by 2 pharmacists. Evaluate potential clinical severity Each ME was evaluated independently by 2 pharmacists. Modified NCC MERP.

II METHODS Determine risk factors of MEs Binary logistic regression with α < 0,05 Independent variables included: complexity of preparation, administration time (day of the week, drug round) experience of nurse clinical ward

Gastroenterology Surgery III RESULTS 1. Rates of MEs   ME OE Rate (%) 3 wards 820 992 82,7 Cardiovascular 166 185* 89,7 Internal 262 303* 86,5 Gastroenterology Surgery 392 504* 78,8

III RESULTS 1. Rates of MEs according to routes ME OE** Rate (%) IV   ME OE** Rate (%) IV 505 100,0 IM 33 IV infusion 282 407 70,5 PO 47 0,0 Total 820 992 82,7

III RESULTS 1. Rates of types of MEs Types of MEs ME Rate (%) Drug wrong 0,0 Dose wrong 1 0,1 Drug form wrong Preparation technique wrong 503 29,2 Drug obmission Time wrong 353 20,5 Route wrong 9 0,5 Injection/Infusion rate wrong 718 41,6 Incompability 140 8,1 Total 1724 100,0

Potential clinical severity III RESULTS 2. Potential clinical severity Types Potential clinical severity No harm (A - C) Need following-up (D) Possibly harm (E - I) Technique wrong 15 (0,9%) 488 (28,3%) Time wrong 353 (2,5%) 0 (0,0%) Route wrong 9 (0,5%) Rate wrong 130 (7,5%) 588 (34,1%) Incompability 140 (8,1%) Dose wrong 1 (0,1%) Total 498 (28,9%) 1226 (71,1%)

Complexity of preparation III RESULTS 3. Risk factors of MEs Factor RR (95% CI) p Complexity of preparation 45.58 (16.51 – 125.83) < 0.01 Day of the week 0.64 (0.40 – 1.03) 0.07 Drug round 0.97 (0.60 – 1.55) 0.89 Experience of nurse 1.18 (0.90 – 1.54) 0.22 Clinical ward 0.82 (0.58 – 1.17) 0.27 administration time (day of the week, drug round)

IV CONCLUSIONS Rate of general ME is 82.7% 100% antibiotics IM and IV having MEs 38.4% quan sát có 2 loại sai sót. Injection/Infusion rate wrong having high rate (41.6%). 1. Rates of MEs related antibiotics preparation and administration 77.1% MEs possibly harm 2. Potential clinical severity Complexity of preparation is an independent risk factor of MEs 3. Risk factors of MEs

V NEXT STEPS Develop a protocol of preparation of injectable antibiotics. Train and evaluate nurses timely. Determine rates and severities of MEs after interventions. Evaluate effectiveness of interventions for improvement.

Hue University of Medicine and Pharmacy Vo Thi Ha. Email: havothipharma@gmail.com Hue University of Medicine and Pharmacy Thank you !